Abstract
BackgroundViral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases. Improved socioeconomic factors, as well as the universal vaccination of infants (introduced in 1999) has resulted in a decline in infection rates in Israel. This study examines the benefits of routine testing for anti-HAV IgG in high-risk population.MethodsA retrospective examination of the files of teenage and adult patients (aged 16–99 years; mean 33.9) in two primary care clinics found 1,017 patients who had been tested for anti-HAV IgG antibodies for either general healthcare screening or ongoing follow-up for chronic illness. Seropositive patients were then asked regarding recall of past hepatitis (i.e. jaundice, regardless of viral etiology); post-exposure prophylaxis with immune serum immunoglobulin (ISG); and active immunization with inactivated virus. Seronegative patients were subsequently sent for active immunization.ResultsOf the1,017 patient records studied (503 male, 514 female), a total of 692 were seropositive (354 males, 338 females; P = 0.113). Seropositivity rates increased with age (p < 0.005), and were highest among those born in Middle Eastern countries other than Israel (91.3%) and lowest among immigrants from South America (44.1%; P < 0.005). 456 of the seropositive patients were interviewed, of whom only 91 recalled past illness while 103 remembered receiving post-exposure prophylaxis (ISG) and 8 active vaccination. Those who were unaware of past infection were more likely to have been vaccinated with ISG than those who were aware (26.3% vs. 7.7%; p < 0.005).ConclusionThe relatively high prevalence rate of anti-HAV seropositivity in our study may me due to the fact that the study was conducted in a primary care clinic or that it took place in Jerusalem, a relatively poor and densely populated Israeli city. Most of the seropostive patients had no recollection of prior infection, which can be explained by the fact that most hepatitis A infections occur during childhood and are asymptomatic. Routine testing for anti-HAV IgG in societies endemic for HAV would help prevent seropositive patients from receiving either post-exposure or preventive immunization and target seronegative patients for preventive vaccination.
Highlights
Viral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases
PFrigevuarlen1ce of positive HAV serology according to age (%) Prevalence of positive HAV serology according to age (%)
Patients who tested seropositive for HAV were contacted and asked regarding the following: demographic data; whether or not they remembered being sick with hepatitis, and when; and whether or not they had been immunized, either passively (ISG) or actively, and when
Summary
Viral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases. Most cases of viral hepatitis in Israel are caused by the hepatitis A virus (HAV), and in the 1970's the Israeli Ministry of (page number not for citation purposes). A total of 1,017 patient files were found which contained serological results of anti-HAV antibodies from blood analyzed in the health fund's central lab, which used a microparticle enzymatic assay (MEA; AxSYM System, Abbott Diagnostics). Patients who tested seropositive for HAV were contacted (either in person or by phone) and asked regarding the following: demographic data (country of birth); whether or not they remembered being sick with hepatitis (i.e. clinical jaundice, with or without known serological evidence of active HAV infection), and when; and whether or not they had been immunized, either passively (ISG) or actively (inactivated virus), and when. Data was compiled and analyzed using the Microsoft Excel program
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